M otor Planning: Praxis.

Motor planning or praxis is the ability of the brain to conceive, organize, and carry out a sequence of unfamiliar actions. In dyspraxic syndrome there is a reduced ability to carry out non-learned movements, even though there is adequate motor and conceptual capacity to do so. Tactile, kinesthetic, and vestibular sensory information are registered from the body and organized into neuronal models, which are replications of the environment and our mechanical selves. This neuronal map, known as body schema, permits effective programming of the sequence of actions involving the whole body that are required in motor behavior. Difficulty with imitative behavior is a key indicator of dyspraxia necessitating that children organize themselves cognitively, rather than perform tasks automatically. This often becomes a source of frustration for them. Praxis is believed to be a single function involving three basic processes: ideation or generating an idea of how one might interact with the environment; motor planning or organizing a program of action; and execution or the actual performance of a motor act.


Motor planning difficulties can manifest on a larger scale in the child's difficulty in organizing their environment and themselves in that environment. Learning routine and how one fits into the routine may take longer. Children with difficulties may perform slowly, or not be able to perform at all, when asked to follow multi-stepped directions. They may require a longer exposure to a new activity in order to learn it. They may initially use trail and error approaches to a task until they can generate a motor plan about how to approach the activity. This can also carry on to higher levels of reasoning. They can have difficulty organizing their thoughts and language to express themselves.


Finally, sensory integration disorders in general can contribute to low self-esteem and anxiety. These children can see they are not doing as well as their peers, however since it is a "hidden difficulty" they may see themselves as "dumb" not recognizing that they may be working twice as hard to compensate. The cost of compensation may be a sense of frustration and the awareness that their body is not keeping up with the tasks that their good little minds are able to conceptualize. It is important to normalize the neurologically based functions of the sensory systems to provide a better foundation for acquisition of higher level skills.


What happens if one or more of those senses are not being interpreted properly. It is easier to understand the problems of a blind or deaf person. Problems of the vestibular, tactile, or proprioceptive system are much more difficult to identify yet the effects of insufficient processing in these system is profound. These three senses are the basis for the organization of the whole nervous system and problems can manifest themselves in a multitude of ways..


T reatment of Children with sensory integration disorders:

Children with sensory integration disorders have deficits in their nervous systems organization of sensory information, that impact on them accurately perceiving and responding to the environment. They need carefully applied and monitored sensory input to enhance the nervous systems ability to organize, so the child is able to develop adaptive behaviors. Research, much done by Dr. Jean Ayres, implicates the brain stem as the most significant location for the integration of sensory information.


Assumptions UNDERLYING TREATMENT:


The nervous system is self-correcting or has a natural ability to heal itself. We assume that the childs behavior is purposeful as an effort to self correct. In treatment we try and figure out what the child is trying to accomplish and help him appease his system in a more adaptive manner.


In treatment we watch what the child is driven by and guided by this we try to meet the childs need. We assume the child holds the answer if we listen correctly. We don't try to extinguish a behavior, rather we respond to the need and then lead the child to a more adaptive behavior.



Engagement of the child is essential. We look to elicit an adaptive response in the child to create new and more accurate perceptual schema.


Concept of Ontogeny (development) recapitulates Phylogeny (evolution): Treatment is developmentally based.


O rganization of Sensations Sensory Integration is the organization of sensations for use so that we can respond to the world in an adaptive manner. It is based on the premise that the primary building blocks of the central nervous system are the senses, particularly the special senses - vestibular, tactile, and proprioception. All other skills are complex processes based on a strong foundation of sensory integration.


The central nervous system receives input from the environment which is organized and processed in order to produce a motor or behavioral response to the incoming input. The response in turn results in hopefully accurate feedback and providing additional input. This is the theory that adaptive responses are self generating. To put simply good sensory integration is the ability to take in, sort out , and connect multi sensory information from the world around us in an organized manner.


Sensory integration "puts it all together" so that when we eat an orange we have a total experience. We sense the orange through our eyes, (we see it), our ears (the sound of the skin peeling), mouth (the taste) our skin (on our hands and fingers and in our mouth) and information from less conscious sensory systems that tell us the exact position of our hand, how wide we open our mouth, how hard to bite down, how much to move our head to our hand. Sensory integration allows us to put this all together to have and experience of eating an orange.


Sensory integration nourishes the brain by helping the brain properly digest the sensory information it receives. Every moment countless bits of sensory information bombard our nervous system. It is estimated that 2 million bits per sec enter the central nervous system. Sensations are the food of the brain. Without adequate sensory information the brain gradually becomes disorganized.


In sensory deprivation tanks at first the person relaxes with the reduction in sensory stimulation, however after prolonged periods gradually the person become disorganized and start to hallucinate sensory information, much like a person in the desert hallucinates water. The brain needs sensation and without it, it will create it's own. With too much unmodulated sensory information a person can become overwhelmed and they can either become over stimulated, or disorganized and hyperactive or they become so overwhelmed that they shut down. We can see examples of this all the time. (Children in malls) So the brain needs sensory information as food yet sensory integration can be thought of as "how we digest that food." Without proper digestion we do not get the nutrients from the foods we eat and without proper sensory integration we do not perceive the world correctly.


A s we are bombarded with all this sensory data there are certain functions the brain must perform: It must

  • -Alert - attend or orient to new and/or important stimuli
  • -Protect - Defend us if a stimuli is too overwhelming: defend us if stimuli is too strong. (Cover ears, eyes, etc.)
  • -Select - filter out the non-essential input.
  • -Organize - Into meaningful perception.


    This is accomplished by out central nervous system. It is done on an automatic level- so we don't have to think about it. This is the first level of sensory integration. We can see examples in the autistic/PDD child where this does not occur.


    Children can fail to respond to input. For example children who don't respond to pain, or over react to light touch. Who don't respond to there name and or find sounds painful that don't bother the rest of us. So right in the most basic level of sensory registration the autistic child is significantly impacted.


    If the input is not processed and organized accurately, the result is abnormal motor output with abnormal feedback. This cycle continues with increasingly more disorganized sensory input and chaotic output and feedback. The consequences of a disorganized central nervous system are developmental lags, behavioral, emotional, and learning problems.


    Many atypical behaviors observed in children with Autism and PDD can be better understood when the effects of a disorganized central nervous system are taken into consideration. These children do not have the same perceptual schema most of us do and therefore they have a different reality. Without an efficient nervous system, we are unable to interact comfortably with the world around us.


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